Transitional Care and Health Care Finance Analysis Essay

Module 4: Transitional Care & Health Care Finance Introduction Module 4 draws our attention to Care Models and Finance. The content will focus on exploring transitional care models and financing for health, long term care, and home health care for the elderly. A highlight of this module is the Transitional Care Project with the goal to identify situations and develop ideas where the BSN nurse can impact the transitional care process improving continuity of care. Research has documented the positive impact of nurse-driven interventions on patient care outcomes involving transitions between outpatient, home care, hospital and long term care settings. Take the time to review the journal articles below to learn more about cumulative outcomes related to current research. Effective communication stands out as a common element among successful transitional care programs that result in improved clinical outcomes, such as the rate of re-hospitalization and mortality after discharge. In this module, you will explore the impact of care transitions between healthcare settings: home to hospital or nursing home; nursing home to hospital or home; and hospital to home or nursing home. Third-party payers are creating incentives and imposing penalties to healthcare organizations who don’t meet expected targets such as 30-day re-hospitalization, catheterassociated urinary tract infections (CAUTI), etc. Not surprisingly, nurses can make a difference. Implementing nurse-driven measures that support continuity of care and consistent communication practices such as follow-up home visits, outreach services, transitional communication tools, discharge planning, and transitional care units improve transitions of patients from the critical care environment to lower level care settings and reduces readmission rates. • • • • • • • • • • • • • • • • • • • Read: Health Aging Policy Brief, 2015 White House Conference on Aging Watch: The Future of Nursing [5:16 mins] Watch: Care:Care: Care Workers, Their Clients, and the Coming Crisis [56mins] optional Watch: Care About Your Care series of seven videos. CEUs have expired but quiz Care About Your Care Quiz is substituted. Links to the individual videos are as follows: 1. Part 1: Improving Transitions [7:47 mins] 2. Part 2: The Challenge We Face [3:36 mins] 3. Part 3: The Revolving Door [26:45 mins] 4. Part 4: Solutions: Inovative Discharge Programs[6:19 mins] 5. Part 5: Mercy Health Case Study [9:53 mins] 6. Part 6: Queen of the Valley Case Study [10:57 mins] 7. Part 7: Panel Q & A [24:10 mins] Read/Review: Transitional Care and Health Care Finance Analysis Essay

Taking Care of Myself: A Guide for When I Leave the Hospital Read: Reducing Avoidable Hospital Readmissions (5 Key Areas) Read: Transitional Care Read: The Transitional Care Model (TCM) Read/Review: Try This: TCM: Hospital Discharge Screening Criteria for High Risk Older Adults Read: Informal Caregivers of Older Adults at Home: Let’s PREPARE! Watch: Global Aging: Challenges and Innovations for Public Policy and the Private Sector [5:09 mins] Watch: Aging in America: Crisis in long-term care [8:58 mins] Watch: Medicare in 4 Minutes [4 minutes] Read/Review: Medicare Advantage Plans 2020 Read/Review: How to compare Medigap policies Watch: Fixing America’s Long-Term Care System [7:36 mins] Review: Policies Affecting Older Adults [PPT] Watch: Health Policy Overview- Stock Lecture below. (HINT—video aligns with the health policy quiz) Kaltura Video Player Journal Articles (log into Library to access articles) • • Allen, J., Hutchinson, A. M., Brown, R., & Livingston, P. M. (2018). User experience and care for older people transitioning from hospital to home: Patients’ and carers’ perspectives. Health Expectations, 21(2), 518-527. doi:10.1111/hex.12646 Library linkAllen article pdf-Allen Article Berre, M., Maimon, G., Sourial, N., Gueriton, M., Vedel, I. (2017). Impact of transitional care services for chronically ill older patients: A systematic evidence review. Journal of the American Geriatrics Society, 65(7): 1597-1608. DOI: 10.1111/jgs.14828. PdfLeBerre Article (skim) • • • • Miller, E. (2018). The state of aging policy and politics in the Trump era. Journal of Aging, 30 (3-4): 193-208. DOI: 10.1080/08959420.2018.1481314 PDF- Miller article Peters, J. S. (2017). Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness. Critical Care Nurse, 37(1), e10-e17. doi:10.4037/ccn2017218 Library Link- Peters article pdf- Peters article Vinson, M. H. (2017). Establishing Consistent Transitional Care Interventions. AAACN Viewpoint, 39(5, 1-11. Library link- Vinson article pdf- Vinson article Weeks, L. E., Macdonald, M., Martin-Misener, R., Helwig, M., Bishop, A., Iduye, D. F., & Moody, E. (2018). The impact of transitional care programs on health services utilization in community-dwelling older adults: a systematic review. JBI Database Of Systematic Reviews & Implementation Reports, 16(2), 345-384. doi:10.11124/JBISRIR2017-003486 PDF- Weeks Article (skim) School of Nursing and Healthcare Leadership RN to BSN Nursing Program NURS 420: Transitional Care (TC) Project Project Introduction This 50 point paper is focused on the transitional care process for a patient discharged or transferring from one care setting to another (example: hospital to nursing home, swing-bed, stepdown rehab, assisted living or home care or vice versa. YOU DO NOT HAVE A REAL PATIENT FOR THIS ASSIGNMENT but consider the potential problems that can occur with an elderly frail client with multiple health problems such as Parksinson’s or early Dementia. An additional 15 point quiz makes the Transitional Care Process worth a total of 65 points. Project Instructions 1. Prepare 1. Read the textbook assignments. 2. Explore web resources & journal articles. 3. Watch all of the Care About Your Care videos 4. Develop a list of questions to be asked during your interview with the healthcare professional, consider challenges and barriers as patients transition from one care setting to another. 5. Interview the healthcare professional with experience in the transitional care process (social worker, RN-Discharge Planner, NP-PA, etc.). 6. Identify the role of the professional nurse or gerontology specialist contributing to the continuity of care transitioning from one location to another. Focus on leadership role the student may have with knowledge gained in this Transitional Care project. Transitional Care and Health Care Finance Analysis Essay

2. Take Care About Your Care (CAYC) Quiz (15 points) The quiz on D2L will evaluate your knowledge after watching ALL the CAYC videos. Take notes paying attention to the specific organizations, interventions and outcomes mentioned in the videos. You will want to reference those in the paper. Complete by date indicated on Schedule-at-a-Glance. 3. Write Essay (50 points) • • • Limited to 1000 words for the body of the paper. (One point may be deducted if you go over.) Include a title page & references – these are not included in the word count. APA format (cover page, running head, headers, reference page, etc.) Essay Content/Format I. Catchy Introduction II. Body – (each section is worth 10 points) 1. Summarize TC process from assigned reading-define TC, describe growing problem with aging population, impact, etc. 2. Reflect on the many specific organizations, strategies & outcomes identified in the CAYC videos. 3. Summarize the Interview –introduce the person, summarize questions/responses with focus on challenges/facilitators/barriers to the TC process. 4. Reflect on the role the BSN/gerontology specialist contributes to the transitional care process III. Conclusion. TC Essay Grading Rubric Essay Content / Format Introduction Points Possible 2 Excellent Competent Developing Catchy, identifies purpose & main points Lacks attention grabbing quality or does not include purpose or main points Lacks attention grabbing quality and no purpose/main points 2 1-1.5 Body1. Summarize TC process 2. Strategies from CAYC video 10 Thorough with depth & critical thinking 10 3. Summarize Interview 9-10 Ideas expressed but not clearly defined, limited understanding or analysis of the issues, elements missing 7-8 Points Awarded 0-1 Unclear, limited summary and/or synthesis, major elements missing 6 or less 10 4. BSN or Gerontology Specialist role in TC process 10 2|Page Conclusion 2 Catchy, summarizes & ties in with intro theme Lacks summary or intro theme to wrap up. 1-1.5 2 Spelling, grammar, writing, etc. 2 APA format 3 1000 Word Count Body of paper 1 Lacks summary and does not reflect intro theme 0-1 50 points Comments: 3|Page …